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General NPI Number Information
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NPI Number | 1497227201
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Entity Type | Individual
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Provider Name | KISHA NATHIMA VALLEJO LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/19/2018
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 1103 WEST STAN SCHLUETER LOOP BUILDING A SUITE 100
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City | KILLEEN
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State | TX
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Zip | 76549
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Country | US
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Telephone | 254-213-7847
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Fax | 254-312-2002
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Provider Business Mailing Address
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Address Line | 1103 WEST STAN SCHLUETER LOOP BUILDING A SUITE 100
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City | KILLEEN
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State | TX
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Zip | 76549
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Country | US
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Telephone | 254-213-7847
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Fax | 254-312-2002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 65621
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License Number State | TX
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